Tri Krianto
"Penyakit Demam Berdarah Dengue (DBD) yang ditemukan pada tahun 1968 di Surabaya dan Jakarta, cenderung terus meningkat. Bahkan kenaikan jumlah kasus tahun 2007 dibandingkan tahun 2006 mencapai lebih dari 40%. Apabila tahun 2006 jumlah kasusnya sekitar 111.000, namun tahun 2007 mencapai lebih dari 150.000 kasus dengan kematian yang diakibatkannya lebih dari 1000 orang. Di Kota Depok jumlah kasusnya juga terus meningkat, dari 312 kasus (1997), 1838 kasus (2006) dan tahun 2007 mencapai 2956 kasus. Semua kelurahan sudah endemis demam bardarah. Strategi premosi kesehatan di kemunitas kurang berhasil menurunkan jumlah kasus demam berdarah. Untuk itu upaya promosi penanggulangan DBD perlu dilakukan melalui sekolah.
Tujuan penelitian ini adalah menilai pengaruh promosi kesehatan yang dilengkapi dengan pemeriksaan jentik berkala terhadap perilaku pengendalian vektor dengue pada murid sekolah dasar negeri (SDN) kelas III, IV dan V di Kota Depok. Dengan demikian, hasil penelitian ini dapat memberikan sumbangan terhadap upaya mengendalikan penyakit demam berdarah, khususnya di Kota Depek.
Disain penelitian ini adalah eksperimen, yang diikuti 642 murid dan 642 ibu. Intervensi yang diberikan pada kelompok perlakuan terdiri dari pelatihan, pendampingan, kampanye serta pemeriksaan jentik berkala. Analisis data secara kuantitatif dilakukan untuk melihat perbedaan antar pengukuran dan antar kelompek terhadap: a) rerata nilai pengetahuan, sikap dan praktek (KAP), dan b) indeks jentik. Untuk itu dilakukan beberapa tahap analisis bivariat dan multivariat selaras dengan tujuan penelitian serta sifat datanya. Untuk memperkaya penjelasan terhadap temuan penelitian kuantitatif dilakukan penelitian kualitatif.
Intervensi promesi kesehatan dan PJB-AS (pemeriksaan jentik berkala anak sekolah) ternyata meningkatkan KAP anak sekelah sebesar 4,25 - 10,28% (p
Sejalan dengan perubahan KAP pada murid, secara umum pengetahuan ibu tentang vektor, gejala DBD dan cara pengendalian vektor meningkat sebesar 4,15 - 12,82%. Sikap ibu berupa rencana tindakan rnenyampaikan informasi tentang demam berdarah kepada suami/anggota keluarga meningkat sebesar 7,84%. Praktek ibu memeriksa habitat perkembangbiakan Ae. aegypri rneningkat sebesar 4,8 5%.
Indeks jentik juga menurun cukup tajam pada kelompok perlakuan. Pada awal penelitian, CI, BI kelompok perlakuan jauh lebih tinggi daripada kelompok kontrol, namun pada akhir penelitian, CI kelompok perlakuan turun 29,02% (p=0,00l), BI turun 20,83% (p=0,00l). Pada kelompok kontrol, CI dan BI juga turun, namun persentasenya rendah yaitu 3,83-8,65%. Uji regressi logislik berganda memberikan gambaran bahwa faktor yang berkontribusi pada CI di awal penelitian adalah praktek ibu mengendalikan vektor, namun pada akhir penelitian, faktor yang berhubungan dengan CI adalah sikap murid. Uji diskriminan yang dilakukan menunjukkan jika sikap murid positif maka CI turun, demikian pula sebaliknya.
Hasil penelitian ini menunjukkan, bahwa intervensi promosi kesehatan yang dilengkapi dengan pemeriksaan jentik secara berkala terbukti efektif meningkatkan pengetahuan, sikap dan praktik (KAP) anak sekolah dan ibu rumah tangga dalam pengendalian vektor DBD, sekaligus menurunkan indeks jentik, utamanya CI dan BI.
Oleh karenanya strategi ini perlu segera direplikasikan pada wilayah-wilayah lain di Kota Depok, dalam rangka menurunkan jumlah kasus demam berdarah. Unluk itu, komitmen pemerintah kota sangat penting untuk menjamin sustainabilitas program. Beberapa bentuk komitmen yang dibutuhkan yaitu: a) aktivasi dan revitalisasi kelompok kerja operasional DBD di tingkat kota, b) menginduksikan muatan penanggulangan DBD ke dalam mata ajaran ilmu pengetahuan alam (IPA) serta rnelengkapinya dengan aktivitas memeriksa jentik berkala, c) mengembangkan jejaring dan koordinasi lintas sektor untuk supervisi dan monitoring program. Apabila akan dilakukan replikasi atau pengembangan atas penelitian ini, maka beberapa hal perlu dipertimbangkan, yaitu: a) menambah muatan substantif, b) memasukkan pertimbangan kualitatif dalam menilai kesetaraan antar kelompok pada eksperimen komunitas, c) menggunakan indikator jentik yang lebih sensitif misalnya indeks pupa, d) melakukan pengukuran terhadap kondisi lingkungan yang diprediksi mempengaruhi perkembangbiakan nyamuk.
Dengue Hemorrhagic Fever (DHF) disease where was found in 1968 at Surabaya and Jakarta tend to increase, moreover the improvement of cases in 2007 compared with 2006 reached more than 40%. When in 2006, the case number was about 111,000, however in 2007 reached over than 150,000 cases, where the death that resulted more than 1,000 people. In Depok Mtuticipality the number of its cases also increased, from 312 cases (1997), 1,838 cases (2006), and in 2007 has reached 2,956 cases. All the Villages in Depok Municipality have been Dengue Hemorrhagic Fever endemic area. Health promotion strategy in community less success in decreasing the number of Dengue Hemotrhagic Fever cases, so that the health promotion to overcome the DHF should be done through schools. The objective of this research is to assess the impact of health promotion provided with larva inspections at periodic to behavior of dengue vector control on schoolchildren of State Elementary School (SDN), grades lil, IV, and V at Depok Municipality. So, the result of this research could give contribution to effort in controlling of DHF disease, especially at Depok Municipality. The design of this research is experiment, it was followed by 642 schoolchildren, 642 mothers, intervention gave to Intervention Group consist of training, adjacent, campaign and also inspection of larva at periodically. Data analysis quantitatively conducted to see thc difference between Control and Intervention groups to: a) average knowledge, attitude, and practice (KAP) assessment, b) larva index. It was conducted some phase analysis of bivariate and multivariate to meet with the objective of this research, and also the nature of its data. To enrich clarification to quantitative research finding, it was also conducted qualitative research. Health promotion intervention and PIB-AS (periodically larval inspection by schoolchildren), in the reality improved KAP to schoolchildren as many as 4.25-10.28% (p<0.05), and to knowledge and attitude of mothers as many as 2.21-12.72% (p<0.05). Knowledge of schoolchildren changing significantly (p<0.05) was on vector increased (7.58%), and on dengue symptom increased (5.32%) Schoolchildren attitude changing significantly (p<0.05) that is on the seriousness of disease, effectiveness of vector control (PSN 3M Plus), and plan of action increased as many as 2.29-11.62%. Schoolchildren practice on vector control (PSN 3M Plus), and check potential habit of propagation of mosquito as many as 8.24-1 l.l5%. Qualitative study was found: a) larva inspection was new and fun activity, b) dtuing intervention female schoolchildren were more serious than male, e) active learning approach in the school health promotion was more favorable and appropriateness. In line with the changing on KAP of schoolchildren, in general, knowledge of mothers on vector, symptom of DHF, and vector control method increased as many as 4.15-12.82% Mothers' attitude in the form of action plan to inform the information on DHF to husband or to family member increased as many as 7.84%. Mothers? practice to check habitat propagation of A e. aegypri increased as many as 4.85%. Larva index also decreased significantly on Intervention Group. In the early research, CI, and BI of Intervention Group much higher than Control Group, however by the end of research, CI of Intervention Group decreased as many as 29.02% (p=0.00l), BI decreased as many as 20.83% (p=0.00l). On Control Group, CI and BI also decreased, however the percentage was low only 3.83-8.65%. Based on Multiple Logistic Regression Test shown that the factors which have contributed to Cl is schoolchildren attitude. Discriminant test which is conducted shovm that, if the schoolchildren attitude positive, so the CI is decreased, it also do on the vise verse. The result of this research indicated that health promotion intervention provided with larva inspection at periodically, it gave proven in increasing the knowledge, attitude, and practice (KAP) of schoolchildren and mothers effectively in controlling the vector DHF, along with degraded the larva index, especially Cl and BI. For the reason, this strategy should immediately replicate to other regions at Depok Municipality, in order to degrade the case number of DHF. Thus, commitment of the Authority of Depok Municipality is very important to guarantee the sustainability of the program. There are several kinds of commitments required, those are: a) activate and revitalization of working group on DHF in the level Municipality, b) integrate material of overcoming the DHF to the subject of Natural Science, it also provided with activity on larva inspection periodically, c) develop the networking and coordination of multi sectors in supervising and monitoring the program. If the replication will be conducted or developed to this research, there many factors should be considered, those are: a) add the substantive material, b) include consideration of qualitative in assessing the equivalence between those groups on community experiment, c) use larva indicator which is more sensitive, for example index pupa, d) conduct the measurement on condition of the environmental, which is predicted influence to mosquito propagation."
Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2008
